SDE: Clinical Guidelines Ch7H

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
Specialized Health Care Procedures

H. Central Line Care


A central line is a catheter most frequently placed through the chest wall into the right atrial chamber of the heart or a large central blood vessel. Central lines are placed internally (implanted), such as portacaths, or externally such as Hickman catheters. In school, central line care should be limited to ensuring that the dressing is occlusive and intact when applicable, intervening in an emergency; or care required to access the line for medication administration or nutrient administration. This procedure may include dressing reinforcement and/or heparin or saline flush.


Long-term access to the circulatory system for medications, fluids, and nutrients.


Gloves, antiseptic wipes/swabs, heparin or saline if ordered, appropriate size needle and syringe, sterile gauze, tape.

An emergency kit containing wipes, injection cap, heparin flushing supplies, dressing change supplies, and an extra clamp should be available at all times.


Flushing or administering medications through a central line

  1. Clean the injection cap for 30 seconds using an appropriate (chlorhexidine, povidone-iodine, alcohol) wipe; allow to air dry.
  2. Using the appropriate flush solution or medication, draw up the solution as ordered.
  3. Inject the flush or medication.
  4. Flush line if ordered following administration of medication (Mannheim, J.K., 2010).

Changing cap on central line

  1. Set up a clean work surface.
  2. Gather all the supplies.
  3. Wash your hands for 15 seconds with liquid antibacterial soap. Dry your hands thoroughly using paper towels.
  4. Make sure that the central venous catheter (CVC) lumens are clamped.
  5. Remove the new cap from its package.
  6. Loosen, but do not remove, the cover on the end of the new cap.
  7. While holding onto the lumen of the CVC with one hand, use the other hand to:
    1. Remove the old cap and set it aside.
    2. Remove the cover from the new cap.
    3. Screw the new cap onto the open end of the lumen. This requires doing a lot with only one hand, but it is important to hold onto the lumen of the CVC to keep it from hanging free and touching anything.
    4. Repeat these steps for each of the lumens.
    5. Follow your routine to change caps in the same order as flushing.

Delegation Considerations

Must be performed by a trained registered nurse.

Select Nursing Considerations

Flushing or administering medications via a central line requires specialized nursing education. Contact an area hospital or other health care groups for training, as necessary. School nurses may need to provide central line care if a student is experiencing symptoms of infection, the catheter is dislodged, or if a student is experiencing shortness of breath or chest pain. Monitoring and ongoing assessments of the central line dressing and site are essential nursing care in a school environment.


Mannheim, J.K. (2010). Central venous catheter - flushing. Retrieved January 14, 2012.


Content Last Modified on 7/23/2014 1:26:03 PM